Rheumatic Fever
17CHAPTER
153
Rheumatic fever is a serious illness
with joint pain and fever. It usually
lasts about 6 weeks but may last up
to 6 months (or rarely more). Then
the joint pain usually goes away
completely. But heart damage, if it
has occurred, may be permanent
or become disabling (shortness of
breath; sickly child).
CAUSES
Rheumatic fever usually results
after a sore throat caused by bacteria
called ‘streptococcus’. (The rheumatic
fever is somewhat like an allergic
reaction.) A ‘strep throat’ often
starts suddenly with throat pain and
fever and without signs of a cold.
Rheumatic fever is most common
where epidemics of strep throat are
common—in crowded communities
with poor hygiene.
PREVENTION
Rheumatic fever can often be
prevented by giving penicillin to
children who have signs of a strep
throat. Keep giving penicillin for at
least 3 days after all signs disappear.
Long-term prevention involves
improving hygiene and living
conditions (a fairer society).
CAUTION: Most sore throats in children
are not ‘strep’, but are caused by the
common cold; these should not be treated
with penicillin, or any other antibiotic and
never injections (see p. 18). Typically, a
strep throat is quite painful and starts
suddenly, with high fever, and without a
stuffy nose or other signs of a cold.
SIGNS OF THE TYPICAL CASE
• Child between the ages 5 to 15
• Began 1–3 weeks after the child had
a severe sore throat
• High fever—child quite sick
• Joint pain. Pain often starts in
one or more of the larger joints
(especially wrists and ankles).
Then it changes to other joints,
often knees and elbows. The
painful joints may swell and
become red and hot.
• Child gets well in about 6 weeks
to 3 months, but may get the same
illness again after another sore
throat.
OTHER SIGNS (not always present)
• Reddish curved lines or rash on skin
• Lumps (the size of peas) under the
skin over or near the joints
• Heart problems. You may hear a
‘murmur’ if you put your ear over
the child’s chest. Instead of the
typical ‘lub-dub . . . lub-dub’ of the
heartbeat, you will hear a soft, long
‘whoosh’ for one of the sounds:
‘whoosh-dub ... whoosh-dub . ..
whoosh-dub’. The ‘whoosh’ sound
means a valve to the heart has been
damaged so that it does not close
completely. In extreme cases this
can lead to heart failure (see Where
There Is No Doctor, p. 325).
• Nosebleed, belly pain, chest pain, or
signs of pneumonia occur in only a
few cases.